I can't figure out why you think that having consumers negotiate what preventative care they want and how much they'll pay for it is going to lead to better outcomes and lower prices than having coverage providers do it. Most people I know -- you may be the exception here -- really would prefer not to have to negotiate these things, both because of information asymmetries and because it's a pain in the ass.

I don't know why you think there will be all this negotiating taking place. For rote preventative care, units will have prices. People aren't going to walk into the doc and say, "How much for a physical? $100? No way. I'll give you $75." It's not going to be a flea market.

Prices will be more transparent, and with that there will be enhancement of competition among providers. This naturally benefits consumers.

Why do you prefer the opaque pricing system we currently use? If you're truly concerned about informational asymmetries, how can you argue against publishing prices to consumers?

__________________
All is for the best in the best of all possible worlds.

That was quite the Trump press conference. I truly cannot stand to hear that man talk.

Maybe it's just thing on Twitter, but I have seen several calls from the Resistance to go all Tea Party and start running progressives in primaries against Dems who vote for Trump nominees. I know I do not have a vested interest in the success of such an endeavor, but it doesn't seem to me that primary challenging red state Democrats is a winning strategy. I do not believe that the proponents of such a plan grasp the fact that an Elizabeth Warren candidate probably won't run well in West Virginia, or other states that went for Trump. With a few exceptions, most Tea Party challenges were in pretty safely red states.

The Dems don't need to win West Virginia. They need to get 80,000 more people from Philly, Detroit, Milwaukee and Madison to the polls. That's priority number 1.

After than, if we can compete in West Virginia, then great, but if we focus the party on winning there, we lose.

I don't disagree.

There are many other things Dems could do to advance their cause, such as putting forward a decent candidate. Or engaging in less identity politics that turns off the people in flyover states. But a number of people who self-identify as The Resistance have decided that giving the Rs a greater majority in the Senate by taking out Manchin or McCaskill and running a far lefty is the way to go.

And you know what, I kind of liked 2003 Elizabeth Warren. I found it interesting that she was so against DeVos, when 2003 Elizabeth Warren was such a proponent of school choice, given how she identified rising property values in good school districts as such a major cause of financial instability for families in The Two Income Trap. But that was before Senator Warren took a bunch of money from teachers unions.

There are many other things Dems could do to advance their cause, such as putting forward a decent candidate. Or engaging in less identity politics that turns off the people in flyover states. But a number of people who self-identify as The Resistance have decided that giving the Rs a greater majority in the Senate by taking out Manchin or McCaskill and running a far lefty is the way to go.

And you know what, I kind of liked 2003 Elizabeth Warren. I found it interesting that she was so against DeVos, when 2003 Elizabeth Warren was such a proponent of school choice, given how she identified rising property values in good school districts as such a major cause of financial instability for families in The Two Income Trap. But that was before Senator Warren took a bunch of money from teachers unions.

I have my own issues with Liz, but she is wicked smaht, adds a useful voice to every debate, and has been astonishingly effective on constituent services. But I like her in the Senate, and I don't think she'd be a great executive.

I'm actually very fond of Jon Tester. I think he could surprise a lot of people in a national race, including a lot of progressives. He's worth a close look, assuming he gets past his 2018 race. I'm also still fond of Kirsten Gillibrand.

You do realize that DeVos is just flat out incompetent, don't you? It's not just an ideological difference. Watching her testimony was painful.

I don't know why you think there will be all this negotiating taking place. For rote preventative care, units will have prices. People aren't going to walk into the doc and say, "How much for a physical? $100? No way. I'll give you $75." It's not going to be a flea market.

Prices will be more transparent, and with that there will be enhancement of competition among providers. This naturally benefits consumers.

Why do you prefer the opaque pricing system we currently use? If you're truly concerned about informational asymmetries, how can you argue against publishing prices to consumers?

This is one of those times when I realize I spent too much time talking to economists.

Sure there will be unit prices. Those unit prices exist now, and are the subject of bargaining between your provider and your insurer, which has a strong interest in forcing them down. If you have to pay for your preventative care yourself, you can't rely on the insurer for that function. You're going to shop around. How often you shop around will depend on your tolerance for collecting unit price information from different providers for the different things and assessing the likelihood that you will need to purchase the different units, and also on your switching costs.

If you think that world is going to produce lower prices, you are totally nuts. No one wants to do that stuff, which is why they are happy to pay an insurer to do it for them. The insurer can do it for a bunch of people at once, taking advantage of economies of scale and scope, and is more sophisticated about this stuff than you are, avoiding information asymmetries.

Prices are completely transparent right now to the insurer, which is the entity with which the provider is negotiating prices. There is plenty of competition between providers, and insurers.

It is true that if you see zero marginal cost to doing a procedure, the cost to your insurer is no disincentive, and you may overconsume. However, your insurer has thought of that, and is very interested in keeping you from obtaining healthcare you don't need. As others pointed out, this is not so much of a problem with preventative care, which is why it's a little odd for you to focus here. Preventative care is not that expensive, and it has the nice effect of reducing costs down the road. So in fact there is a danger in preventing people from buying insurance to cover it, since they may then under consume.

It doesn't benefit consumers to force them to participate in a market they don't want to be in. Would you rather buy a pass that lets you ride the bus for a month, or would you rather negotiate whether and how much you'll pay each time you board? If you take the bus much at all, and I'm sure you don't, you'll know it's the former.

__________________“Faced with the choice between changing one’s mind and proving that there is no need to do so, almost everyone gets busy on the proof”
- John Kenneth Galbraith

Or engaging in less identity politics that turns off the people in flyover states.

Yeah, that's what I mean. Stepping back on civil rights isn't going to be a winning strategy. Even if there are any white guy votes to by acquired that way (doubtful, especially when your opponent is promising to actively harm the people they dislike), it comes with a side effect of progressive and voters of color staying home.

And, frankly, I'd rather lose than stop being the party that stands up for marginalized people.

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And you know what, I kind of liked 2003 Elizabeth Warren.

Honestly, I've never liked Elizabether Warren. I mean, she's good on policy for the most part, but there's something affected-third-grade-teacher about her persona that I've always found off-putting.

That's probably grounded in mysogny.

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But that was before Senator Warren took a bunch of money from teachers unions.

Or maybe she figured out that DeVos-style school choice doesn't work and that the interests of rich suburbanites shouldn't really be driving policy decisions.

This is one of those times when I realize I spent too much time talking to economists.

Sure there will be unit prices. Those unit prices exist now, and are the subject of bargaining between your provider and your insurer, which has a strong interest in forcing them down. If you have to pay for your preventative care yourself, you can't rely on the insurer for that function. You're going to shop around. How often you shop around will depend on your tolerance for collecting unit price information from different providers for the different things and assessing the likelihood that you will need to purchase the different units, and also on your switching costs.

If you think that world is going to produce lower prices, you are totally nuts. No one wants to do that stuff, which is why they are happy to pay an insurer to do it for them. The insurer can do it for a bunch of people at once, taking advantage of economies of scale and scope, and is more sophisticated about this stuff than you are, avoiding information asymmetries.

Prices are completely transparent right now to the insurer, which is the entity with which the provider is negotiating prices. There is plenty of competition between providers, and insurers.

It is true that if you see zero marginal cost to doing a procedure, the cost to your insurer is no disincentive, and you may overconsume. However, your insurer has thought of that, and is very interested in keeping you from obtaining healthcare you don't need. As others pointed out, this is not so much of a problem with preventative care, which is why it's a little odd for you to focus here. Preventative care is not that expensive, and it has the nice effect of reducing costs down the road. So in fact there is a danger in preventing people from buying insurance to cover it, since they may then under consume.

It doesn't benefit consumers to force them to participate in a market they don't want to be in. Would you rather buy a pass that lets you ride the bus for a month, or would you rather negotiate whether and how much you'll pay each time you board? If you take the bus much at all, and I'm sure you don't, you'll know it's the former.

You don't think about economics, mental health, or overconsumption as much as Sebby does.

This is one of those times when I realize I spent too much time talking to economists.

Sure there will be unit prices. Those unit prices exist now, and are the subject of bargaining between your provider and your insurer, which has a strong interest in forcing them down. If you have to pay for your preventative care yourself, you can't rely on the insurer for that function. You're going to shop around. How often you shop around will depend on your tolerance for collecting unit price information from different providers for the different things and assessing the likelihood that you will need to purchase the different units, and also on your switching costs.

If you think that world is going to produce lower prices, you are totally nuts. No one wants to do that stuff, which is why they are happy to pay an insurer to do it for them. The insurer can do it for a bunch of people at once, taking advantage of economies of scale and scope, and is more sophisticated about this stuff than you are, avoiding information asymmetries.

Prices are completely transparent right now to the insurer, which is the entity with which the provider is negotiating prices. There is plenty of competition between providers, and insurers.

It is true that if you see zero marginal cost to doing a procedure, the cost to your insurer is no disincentive, and you may overconsume. However, your insurer has thought of that, and is very interested in keeping you from obtaining healthcare you don't need. As others pointed out, this is not so much of a problem with preventative care, which is why it's a little odd for you to focus here. Preventative care is not that expensive, and it has the nice effect of reducing costs down the road. So in fact there is a danger in preventing people from buying insurance to cover it, since they may then under consume.

It doesn't benefit consumers to force them to participate in a market they don't want to be in. Would you rather buy a pass that lets you ride the bus for a month, or would you rather negotiate whether and how much you'll pay each time you board? If you take the bus much at all, and I'm sure you don't, you'll know it's the former.

1. People have never been offered an option to the TPA system. It's been the rule for as long as anyone can recall. Hence, the assumption people prefer it doesn't hold.

2. That people are joining concierge practices indicates people do not resoundingly prefer a TPA structure. They prefer direct purchase.

3. Insurance is a far bigger headache to consumers than direct price shopping.

4. Here's the important point...

Providers inflate unit prices enormously to offset the discount insurers demand. This inflates costs across the board, including costs for catastrophic and chronic care.

Pull the insurer out of one form of care, preventative, and you'll remove the inflated price charged by providers in that area. Where the provider charged $1000 for something in order to get $150 from an insurer, now it'll only be able to charge the direct consumer something along a lines of $150, the true value of the service. When that price falls, so to will the prices charged for catastrophic and chronic care, as they inform each other.

You see where I'm going. Pull the inflating mechanism out of any single area of care (preventative, chronic, or catastrophic), and it deflates or at least flatlines or pares the level on increase in the prices in the others. I only chose to apply it to preventative care first because that's the only care a consumer could afford to purchase directly.

__________________
All is for the best in the best of all possible worlds.

1. People have never been offered an option to the TPA system. It's been the rule for as long as anyone can recall. Hence, the assumption people prefer it doesn't hold.

2. That people are joining concierge practices indicates people do not resoundingly prefer a TPA structure. They prefer direct purchase.

You don't seem to realize that your 1. and 2. contradict each other. Also, no one requires TPAs to cover preventative care in the way that they do. If it really made things cheaper in a way that was valuable to consumers, why isn't it out there in a bigger way?

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3. Insurance is a far bigger headache to consumers than direct price shopping.

Not sure what this means or what your point is. You're suggesting the worst of both worlds -- consumer still need insurance for most health care (in spending terms), but are compelled to buy direct for preventative care.

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4. Here's the important point...

Providers inflate unit prices enormously to offset the discount insurers demand. This inflates costs across the board, including costs for catastrophic and chronic care.

Pull the insurer out of one form of care, preventative, and you'll remove the inflated price charged by providers in that area. Where the provider charged $1000 for something in order to get $150 from an insurer, now it'll only be able to charge the direct consumer something along a lines of $150, the true value of the service. When that price falls, so to will the prices charged for catastrophic and chronic care, as they inform each other.

I think the fact that you think this is true is the root of the problem. Providers have "prices" that they give to consumers, and charge people who turn out to be uninsured, and then they have the real prices that they negotiate with insurers. The "prices" are not usually the real prices. Providers don't charge $1000 to get $150 from an insurer. They know they are going to get $150 from the insurer, and they will get that $150 regardless of whether they tell you that the price is $1,000,000,000, $1000, or $150. The only people who pay $1000 are the people who have no coverage, and they get screwed because they have no bargaining power and huge information asymmetries. What you don't seem to understand is that price is a function of both supply and demand, and that buying medical care through an insurer gives you, a consumer, better bargaining power. That $1000 "price" is a reflection of what happens when the consumer doesn't have it. You think that taking consumers' bargaining leverage away and forcing them to negotiate individual with providers is going to leave them better off. For some, perhaps, which is why you have concierge services. But let's assume that people are rational, because you haven't identified any way in which people are predictably acting irrational here -- for all the people who *aren't* using concierge services right now, isn't that a pretty strong indication that they don't want to, and would be worse off if you took their first choice away?

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You see where I'm going. Pull the inflating mechanism out of any single area of care (preventative, chronic, or catastrophic), and it deflates or at least flatlines or pares the level on increase in the prices in the others. I only chose to apply it to preventative care first because that's the only care a consumer could afford to purchase directly.

You haven't identified an "inflating mechanism".

__________________“Faced with the choice between changing one’s mind and proving that there is no need to do so, almost everyone gets busy on the proof”
- John Kenneth Galbraith